Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May 6;9(5):e84701.
doi: 10.1371/journal.pone.0084701. eCollection 2014.

Cost drivers for voluntary medical male circumcision using primary source data from sub-Saharan Africa

Lori Bollinger  1 , Adebiyi Adesina  1 , Steven Forsythe  1 , Ramona Godbole  2 , Elan Reuben  3 , Emmanuel Njeuhmeli  3
Affiliations

Cost drivers for voluntary medical male circumcision using primary source data from sub-Saharan Africa

Lori Bollinger et al. PLoS One. .

Abstract

Background: As voluntary medical male circumcision (VMMC) programs scale up, there is a pressing need for information about the important cost drivers, and potential efficiency gains. We examine those cost drivers here, and estimate the potential efficiency gains through an econometric model.

Methods and findings: We examined the main cost drivers (i.e., personnel and consumables) associated with providing VMMC in sub-Saharan Africa along a number of dimensions, including facility type and service provider. Primary source facility level data from Kenya, Namibia, South Africa, Tanzania, Uganda, and Zambia were utilized throughout. We estimated the efficiency gains by econometrically estimating a cost function in order to calculate the impact of scale and other relevant factors. Personnel and consumables were estimated at 36% and 28%, respectively, of total costs across countries. Economies of scale (EOS) is estimated to be eight at the median volume of VMMCs performed, and EOS falls from 23 at the 25th percentile volume of VMMCs performed to 5.1 at the 75th percentile.

Conclusions: The analysis suggests that there is significant room for efficiency improvement as indicated by declining EOS as VMMC volume increases. The scale of the fall in EOS as VMMC volume increases suggests that we are still at the ascension phase of the scale-up of VMMC, where continuing to add new sites results in additional start-up costs as well. A key aspect of improving efficiency is task sharing VMMC procedures, due to the large percentage of overall costs associated with personnel costs. In addition, efficiency improvements in consumables are likely to occur over time as prices and distribution costs decrease.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Predicted average and marginal cost of VMMC programs.
Red square: Average cost. Blue diamond: Marginal cost.
Figure 2
Figure 2. Predicted economies of scale of VMMC programs.
Blue diamond: predicted economies of scale.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Schwartländer B, Stover J, Hallett T, Atun R, Avila C, et al. (2011) Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377 ((9782)): 2031–2041 10.1016/S0140-6736(11)60702-2 - DOI - PubMed
    1. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, et al. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 369 ((9562)) 657–666. - PubMed
    1. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, et al. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 369 ((9562)) 643–656. - PubMed
    1. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2 ((11)) e298 doi:10/1371/journal.pmed.0020298 - PMC - PubMed
    1. Njeuhmeli E, Forsythe S, Reed J, Opuni M, Bollinger L, et al. (2011) Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS Med 8 ((11)): e1001132 10.1371/journal.pmed.1001132 - DOI - PMC - PubMed

Publication types

Grants and funding